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Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to providers’ performance on a set of defined measures in an effort to achieve better value. VBP requires the assessment of clinical quality through benchmarking of specific outcome measures. VBP programs administered through the Centers for Medicare & Medicaid Services (CMS) include the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifiers (VM), which are soon to be incorporated into Merit-Based Incentive Payment Systems (MIPS). Benchmarking is also required by accrediting agencies, Quality Improvement Organizations (formerly known as Peer Review Organizations), advocacy groups, corporate America (e.g., Leapfrog Group), specialty society clinical data registries (e.g., Society of Thoracic Surgeons database registry, the American College of Surgeons’ National Surgical Quality Improvement Program, the Anesthesia Quality Institute’s National Anesthesia Clinical Outcomes Registry), insurers and managed care organizations. And finally, anesthesiologists benchmark for themselves. Anesthesia groups may use clinical benchmarking to decide where to focus their quality management resources or to market their value proposition. Obviously, the choice of the quality metrics to be benchmarked depends on the intent of the application. For example, for quality improvement one might choose metrics where one is believed to be a poor performer, and for marketing value one would want to choose metrics likely to suggest a strong performance. Unfortunately, anesthesiologists do not always have a choice of the metrics being benchmarked, and the intent is not always clear.